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BIBEKSHEEL
PARTY
Campaigner Form
First Name नाम
Last Name थर
Email इमेल
Choose a Province
Choose a Province प्रदेश
Choose District
Choose your district जिल्ला
Choose Local Level
Choose your Local level स्थानीय तह
Code कोड
Phone मोबाइल नं
How do you like to join us?
Member
Volunteer
Campaigner
Financial Supporter
Citizenship ID/Passport नागरिकता/राहदानी
Upload Citizenship ID/Passport
Upload supported file (Max 15MB)
Do you have any disability? तपाईंलाई अपाङ्गता छ?
Yes
No
Ethnic Origin जात/जाति
Choose an option
Gender लिंग
Choose an option
Voter Id Number मतदाता परिचयपत्र नं
Citizenship Number नागरिकता नं
I hereby confirm that I am a citizen of Nepal and above 18. I agree to be a member of Bibeksheel Party and agree to abide by its statute. I give the permission to save, use my data for party internal purposes and contact me by various means. म १८ वर्ष पुगेको नेपाली नागरिक हुँ भनी स्वघोषणा गर्छु । मेरो स्वेच्छाले नै विवेकशील पार्टीको सदस्य भएको र यसका विधान तथा नियमहरूको पालना गर्न म प्रतिबद्धता व्यक्त गर्छु । मेरा व्यक्तिगत जानकारीहरूलाई संग्रह गरी पार्टीको आन्तरिक प्रयोजनको लागि उपयोग गर्नको तथा मलाई विभिन्न माध्यमबाट सम्पर्क गर्नको लागि म अनुमति दिन्छु ।
If you were a member of another party in the past, party's name and your position विगतमा अन्य दलको सदस्यता रहेको भए दलको नाम र पद
Facebook Profile Link फेसबुकको प्रोफाइल लिंक वा नाम
Register
What city you reside right now? तपाईं हाल बसोवास गरिरहेको सहर
Country you reside now तपाईं हाल बसोवास गरिरहेको देश
Select a country
Ward No. वडा नं
Your Signature हस्ताक्षर
Clear
Member ID
Date Of Birth जन्ममिति
Member Number
Citizenship ID/Passport Next Page नागरिकता/राहदानी पछाडी
Upload Citizenship ID/Passport (next page)
Upload supported file (Max 15MB)
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